Wi MC Sprout LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

WI MC SPROUT LLC

Practice address

11414 W Park PL Ste 202
Milwaukee, WI 53224-3500

Phone

(833) 991-2368

Fax

(929) 384-7193

NPI assigned

Mar 16, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yury Yakubchyk, MD

Title

Owner

Phone

(833) 384-7193

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1972188449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "833-991-2368",
            "fax_number": "929-384-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WI MC SPROUT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "YAKUBCHYK",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "833-384-7193",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elemy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffrey Clement Whittle, M.D.
• Jonae' Lauren Whitver, RN
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• Wi Institute for Neurologic & Sleep Disorders, SC
• Wi LTC Pharmacy Services LLC
• Kathryn M Wiberg, COTA
• Wic Prenatal Services LLC
• Wicare Personal Care Agency
• Thomas Adam Wichelmann, DO
• Christopher Karl Wichert, DPT

• Behavior Analyst in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.